Program boosts GP obstetrics

AN innovative GP obstetric training and support program in rural Victoria has been credited with shoring up GP obstetric services in the region, with experts saying it could help to bolster GP obstetric services in rural areas across Australia.

The implementation of the Gippsland GP obstetric training program has been matched with an increase in the number of GP obstetricians practising in the region from 31 in 2007 to 39 in 2013, according to the authors of a qualitative study published in the MJA. (1)

The program — which includes bridging posts in GP-led obstetric practices, continued professional development and ongoing specialist-led support and mentoring — is aimed at overcoming barriers to rural GPs providing obstetric services in rural Australia.

Professor Caroline De Costa, professor of obstetrics and gynaecology at James Cook University, Queensland, was enthusiastic about the Gippsland approach to supporting GP obstetric services.

“It comprehensively addresses the three main issues that concern GP obstetricians at all stages of their careers — isolation, work–life balance and being able to provide safe care for women and newborns”, she told MJA InSight.

“We are very familiar with these problems in Far North Queensland where a more informal arrangement of support and ongoing training for GP obstetricians, especially those who have completed the advanced diploma course [of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists] in Cairns Hospital, has been in place for around 20 years.”

Professor De Costa said that if given appropriate motivation and funding, the Gippsland program would be transferable to other rural areas of Australia.

In an accompanying editorial, Professor Wendy Brodribb, associate professor of general practice at the University of Queensland’s school of medicine, said obstetric workforce shortages — both specialist and GP — and the closure of 50 birthing services across Australia in the 5 years to 2011 had resulted in less-than-ideal maternity service provision. (2)

“The need to travel outside their community to give birth causes family disruption and increases the risk of women not giving birth in hospital”, she wrote. “Further reductions in the number of GP obstetricians will exacerbate this situation.”

Associate Professor Lucie Walters, president of the Australian College of Rural and Remote Medicine (ACRRM) and associate professor of rural medical education at Flinders University in SA, said maternity, antenatal and postnatal services were vital to the wellbeing of women and rural communities.

“We need to be ensuring that, wherever possible, women are able to have their babies as close to home as is safe for them. Small hospitals with well trained GP obstetricians who are doing well supported, low-risk obstetric care with good networks to regional and tertiary hospitals are just vital for the wellbeing of our rural communities”, said Professor Walters, who also practises as a GP obstetrician in rural SA.

International studies had shown a direct link between the antenatal, intrapartum and postnatal care of women and the overall health and wellbeing of the community, and ACRRM had recognised this by emphasising women’s health in its primary curriculum, she said.

By drawing together existing state and federal funded resources, the Gippsland program had enabled new trainees to confidently take their place as rural GP procedural obstetricians and improve the retention of existing GP obstetricians in rural areas, she said.

“They have been able to align a number of scattered ducks [with this program].”

Professor Walters said the challenges for rural GP obstetricians identified in the research were universal and the program was likely to be transferable to many regions across Australia.

“Speaking about my personal journey, the time that I have felt most vulnerable in terms of being recruited and then retained as a GP obstetrician was when I first arrived in town and was not confident about the transition from tertiary hospital to general practice-led obstetric services”, Professor Walters said, adding that informal local networks were very positive and supportive at this time and later when she had children.

However, she said support networks were dependent on “numbers on the ground” and would be more difficult to arrange in areas of workforce shortage.